Healthcare Provider Details

I. General information

NPI: 1598863193
Provider Name (Legal Business Name): LAWRENCE ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 FROST ST STE 204
SAN DIEGO CA
92123-2739
US

IV. Provider business mailing address

7930 FROST ST STE 204
SAN DIEGO CA
92123-2739
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-3200
  • Fax: 858-939-3213
Mailing address:
  • Phone: 858-939-3200
  • Fax: 858-939-9213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number21500
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: